Elm and North explores the life of Morris Proot, a school bus driver who is slowly turning to bone. With his girlfriend gone and his best friend dead, Proot sinks into isolation after a fight on his school bus forces him into a mind-numbing job as a crossing guard. Seeking comfort, he reaches out to an enigmatic University of Pennsylvania genetics professor, the foremost researcher of his disease. But when Proot's attempts at communication go unanswered, he downspirals into frustration and wretchedness. In an act of final despair, he travels to Philadelphia for a face-to-face confrontation with the one man he feels owes him answers, solace, and maybe even a little hope. The story of a lonely man's battle against a horrific disease, Elm and North is of course a comedy.

The disease at the heart of Elm and North--fibrodysplasia ossificans progressiva (FOP)--results from a rare genetic mutation that causes the body to replace injured soft tissue with bone. As time and excess bone accumulate, victims of FOP can transform into living statues, rigid to the point of complete immobility yet with fully functioning minds. Robbed of his ability to speak coherently, the only authentic voice left to Proot is a written one. Elm and North transpires before smartphones and tablet computers existed. Consequently, in face-to-face interactions, Proot must communicate by scribbling short notes on a portable whiteboard. Only at home, seated before his typewriter, can he "speak" at length and in depth, revealing his character along the way. His predicament mines a rich vein of irony. Morris Proot: inwardly so fluent, outwardly all but voiceless.

Elm and North distinguishes itself by externalizing a disease-inspired interiority and does not rest content with the externalization inherent in Proot's letters. Elm and North steals the aesthetic of those letters and expands it to unify the novel as a whole. Proot's epistolary voice--sometimes acid, sometimes humorous, sometimes elegiac--establishes the emotional intensity that suffuses the novel's alternating points-of-view and blends them to produce a consistent effect.